Robotic Oncology 2018

Sessions/Tracks

Track-1: Robotics and cancer

Cancer is a group of diseases in which cells undergo abnormal growth and divide uncontrollably even invading other parts of the body. There are two types of cancers, benign and malignant of them benign is not severe and less invasive but malignant cancers are more severe and can easily invade into other parts of the body. Most common type of cancer’s include breast cancer, prostate cancer, basal cell & melanoma, colon cancer, lung cancer, Leukemia and lymphoma. Tobacco use is main cause of about 22% of cancers. Another 10% of cancers are due to obesity, poor diet, lack of physical activity and excessive intake of alcohol. Infections, exposure to ionizing radiations and pollutants causes cancers. Signs and symptoms of cancers include formation of lumps, abnormal bleeding, prolonged cough, weight loss and changes in bowel movements. The most common type of cancers in males includes lung cancer, prostate cancer, stomach cancer and colorectal cancer. Most common cancers in females are breast cancer, cervical cancer lung cancer and colorectal cancer.

In order to perform the surgery of cancer with more precision and comfortable to the patient robotic surgeries are preferred. Robotic surgeries are preferred for their better precision capacity, making less number of incisions and fast healing.

Robotic assisted surgery or robotic surgery allows to perform surgeries with high precision, flexibility and control than is possible with conventional techniques. It is minimally invasive surgery which means the surgery is done to patient without making large incisions, they use small size instruments so that it makes even quarter inch of incision. Robotic fourth arm has a magnified high definition 3-D camera that guide’s the surgeon during the surgery.

The surgeon controls the four arms of robot containing the instruments and camera through the console located in the operating room .Surgeon places his fingers into the master controls, where the surgeon can operate the four arms of the robot simultaneously could have a clear glance through a stereoscopic high definition monitor into the patient. First robot assisted laparoscopic radical prostatectomy was performed in the year 2000. Other devices which were developed in robotics included a surgical scrub nurse robot which handled instruments on voice command and a medical laboratory robotic arm. It is minimally invasive surgery which means the surgery is done to patient without making large incisions, they use small size instruments so that it makes even quarter inch of incision. World’s most advanced robot da Vinci Si the miniaturized instruments are mounted on 3 separate robotic arms, allowing the surgeon with maximum precision and motion. Robotic fourth arm has a magnified high definition 3-D camera that guide’s the surgeon during the surgery.

The surgeon controls the four arms of robot containing the instruments and camera through the console located in the operating room .Surgeon places his fingers into the master controls, where the surgeon can operate the four arms of the robot simultaneously could have a clear glance through a stereoscopic high definition monitor into the patient. First robot assisted laparoscopic radical prostatectomy was performed in the year 2000. Other devices which were developed in robotics included a surgical scrub nurse robot which handled instruments on voice command and a medical laboratory robotic arm. ROBODOC was introduced to mill out precise fittings in the femur for replacement of hip.

In robotic surgery instead of directly moving the instruments, surgeon uses one of the 2 methods to control, either a direct tele-manipulator or through computer control. A tele-manipulator (remote manipulator), that allows the surgeon to perform the normal movements associated with the surgery while the robotic arms carry out using the end-effectors and manipulators to perform the actual surgery of the patient. In computer controlled systems surgeon uses the computer to handle the robotic arms and end-effectors. Advantage of using the computerized method is that the surgeon does not have to be present he could be any, where in the world leading to possibility of remote surgery.

There are many robotic surgeries performed to different organs in particular methods, in early 2000 the general surgery interventions were performed by da Vinci device by the surgeons. Reports were published in oesophageal and pancreatic surgery for the first in the world and the data was subsequently was subsequently furnished by Horgan and his group at university of Illinois. Later in 2007 the medical team which was led by Professor Pier Cristoforo giulianotti reported a pancreatectomy and also the Midwest’s first fully robotic Whipple surgery.

Hepatic lobectomy is performed when the tumours are centrally located or presence of large tumours on the liver. In this hepatic lobectomy one of the two lobes of the liver may be removed. By the state of art technology known as the da Vinci system our physicians can perform minimally invasive procedures to remove small portion of the liver through small incisions through extraordinary precision and control.

Depending on the number of tumours and stage of tumour in patient radio frequency ablation (RFA) is the treatment option for liver cancer. RFA uses alternating radiofrequency electric current to destroy the tumours in the liver. RFA can be performed to test tumours in kidney, liver, lung and bone and less commonly even tests other organs of body. RFA may be combined with locally delivered chemotherapy to treat hepatocellular carcinoma. RFA became increasingly important in the case of benign bine tumours most probably osteoid osteomas.

Blood is the important variable that influences the post-operative outcome of hepatic resection. To perform the hepatic resection more safely and also to minimize the blood loss and need for blood transfusions, it is needed to be familiar with different hepatic vascular occlusion techniques. Application of each technique is based on the type of resection to be performed tumour size and location & preoperative liver function. More importantly different methods of vascular control have distinct physiologic and hemodynamic effects systemically and within the liver itself and choice of which method to use to be determined by the patient’s ability to tolerate. The array of vascular occlusion techniques ranges from Pringle’s maneuver to that of total vascular exclusion including inflow occlusion, hemi hepatic clamping and ischaemic pre conditioning. Inflow occlusion by hepatic pedicle clamping has showed reduce blood loss during hepatic resection.

Da Vinci system allows surgeon to perform trans-oral robotic surgery (TORS) for head and neck cancer. Compared to that of the normal surgery TORS leaves no scars and prevents difficulty in swallowing and breathing after normal surgery. Throat cancers include parts like oral cavity, nasopharynx, oropharynx, hypo pharynx, larynx and trachea. Trans-oral robotic surgery is performed only in benign tumours and early to moderate stages of cancerous tumours and for benign base of tongue resection procedures.

Traditional surgery of head and neck disease is done on making a cut on neck, face or splitting the jaw bones (mandibles) to reach the tumour in order to remove it. Robots have allowed access to reach to these difficult regions of the throat without making a cut. At present there is only one robot which is assigned to do trans-oral robotic surgery.

By performing the head and neck surgery by TORS there would be additional benefits to the patient includes:

a) The uterus plus one (unilateral) ovary and fallopian tube are removed or

b) The uterus plus two (bilateral) ovaries and fallopian tubes are removed.

With drawl of uterus, cervix, both ovaries, both fallopian tubes and nearby tissues is radical hysterectomy. These procedures are done using a vertical incision or transverse incision. In this robotic hysterectomy small incisions are made for the surgery, which are smaller than the incisions done in open surgery, so there will be less tissue trauma and less scars when compared to that of the normal traditional hysterectomy.

Hysterectomy is the complete removal of uterus, which ends menstruation and ability to become pregnant. Supra-cervical hysterectomy is removal of upper part of uterus leaving behind the cervix. Total hysterectomy is the complete removal of cervix and uterus. A total hysterectomy along with bilateral salpingo-oophorectomy is the removal of uterus, cervix, fallopian tubes and ovaries. A radical hysterectomy along with bilateral salpingo-oophorectomy is removal of uterus, cervix, fallopian tubes, ovaries, upper portion of vagina and some surrounding tissues and lymph nodes.

In Salpingo-oophorectomy fallopian tube (salpingectomy) and ovary (oophorectomy) are removed. Unilateral salpingo-oophorectomy is appropriate for patients in whom ovary is unable to be preserved and also in case of ruptured ectopic pregnancy with an inability to achieve hemostasis without removal of tube and ovary.

Thyroidectomy is that in which one or both the lobes of the thyroid gland are removed. The most common indications of thyroidectomy are difficulty in breathing related to thyroid mass, large mass in the thyroid gland, suspected or proven cancer in thyroid gland, difficulties in swallowing and hyperthyroidism. Thyroid gland produces three main hormones thyroxine (T4), triiodothyronine (T4) and calcitonin.

Toxic thyroid nodule produces too much of thyroid hormone, resulting in hyperthyroidism. Thyroidectomy is different from thyroidotomy which is cutting of thyroid gland and not removal of thyroid gland.

After the removal of thyroid patients usually take prescribed oral synthetic hormones- levothyroxine to prevent hyperthyroidism.

Endoscopic thyroidectomy is also called as minimally invasive video assisted thyroidectomy.in this it allows the surgeon to perform the thyroid surgery through a small incision on the neck. Use of both fibre-optic endoscopic telescopes and harmonic scalpels made it practically possible for removing the parathyroid tumours as well as small and medium sized thyroid glands from making small incisions as small as one inch. Resulting in smaller incisions and less painful resulting in smaller fine scars .This require short time for recovery.

Robot-assisted laparoscopic surgery is designed to overcome the limitations of the minimally invasive technique includes lack of mobility of current laparoscopic instruments and difficulty in operating in tight places such as pelvis.

Robotic surgery is similar to the laparoscopic surgery, which can be performed through smaller cuts than open surgery. Surgeon can make the small precise movements using this method. Once the robot is kept in the abdomen then it is easier for the surgeon to use the surgical tools than with a laparoscopic surgery through an endoscope.

Da Vinci robotic surgery is computer assisted robotic surgery that expands the surgeon capability to operate with in the abdomen in less invasive way during surgery.it allows greater precision and visualization when compared to standard laparoscopic surgery.

Several small keyhole incisions will be made then they allow passage of carbon dioxide into the abdomen to expand it. This makes the doctor to have a clear view at the time of surgery. Small camera will be passed through one of the incision which is said to be endoscope. It lights, magnifies and projects the image of the organ on to the video screen. Endoscope will be attached to one of the robotic arms, and the other arm will hold the surgery tools to grasp, cut, dissect and suture. Surgery tools include forceps, scissors, dissectors and scalpels.

Oesophagectomy is with drawl of oesophagus through surgery. This is done for patients with oesophageal cancer. It is normally done at the early stage of oesophageal cancer. Instead of significant improvement in techniques and postoperative care long term survival of oesophageal cancer is still poor. Currently multimodality treatment is needed (chemotherapy and radiation therapy) for advance tumours. Oesophagectomy is performed occasionally for benign diseases such as oesophageal atresia in children and achalasiaor caustic injury.

In most of the cases stomach takes the place originally occupied by oesophagus. In some cases oesophagus removed is replaced by a hollow structure colon. Another choice which is going to be available is minimally invasive technique which is performed laparoscopically and thoracoscopically. Oesophagectomy is a complex process which takes 4-8 hrs for the completion of surgery.

Oesophagectomy is a very complex operation which is performed by the specialists in upper gastrointestinal surgery. Anaesthesia given at the time of oesophagectomy is also complex, owing to problems with managing patient’s airway and lung function during the operation. High chances of lung collapse as well as loss of diaphragmatic function and possibility of injury to the spleen.

Stages of cancers (stage 1, 2 &3) in the upper part of the rectum can be removed by the lower anterior resection (LAR). In this operation part of the rectum containing tumour is removed. The colon is attached to remaining part of the rectum so that the bowl moves in usual way. The surgeon makes several small incisions in the abdomen. Then the surgeon removes the tumours in abdomen and margin of normal tissues lining the tumour on the either sides of the cancer along with lymph nodes and other tissues around the rectum.

Lower anterior resection formally known as anterior resection of the rectum is a common surgery for rectal cancer. Lower anterior resection syndrome comprises collection of symptoms mainly that affects patients after surgery for rectal cancer characterized by fecal incontinences, fecal urgency, frequent bowel movements and bowel fragmentation. Presence of ileostomy or time of ileostomy closure is not associated with the development of lower anterior resection syndrome. Ileostomy keeps the solid wastes moving out through colon and rectum, which allows anastomosis to heal. Lower anterior resections give a better quality of life than abdominoperineal resections. During the surgery part of small intestine is brought out through opening in the abdomen which is called stoma.

Camera and instrument bearing arms of the robot are inserted by making small incisions on the abdomen and the abdomen is inflated with gas. In order to expose the kidney surface the fat covering the kidney surface is trimmed away and the colon is moved away from the kidney and blood flow to the kidney is temporarily halted to prevent the excess blood loss at the time of tumour cut and remaining kidney surface is sutured together. After the kidney is reconstructed and blood flow is restored kidney is carefully inspected to check there’s no blood loss. Recently the radical nephrectomy procedure is performed by making single incision in the patient’s belly-button. This advanced technique is called single port laparoscopy.

A simple nephrectomy is suggested to patients with irreversible kidney damage due to symptomatic chronic infection, obstruction, calculus disease or severe traumatic infection. Nephrectomy procedure varies depending on how the surgery is performed and amount of kidney to be removed. Variations include;

Gastrectomy is the surgery to remove part of the stomach. If one part of the stomach is removed it is partial gastrectomy, if whole stomach is removed it is total gastrectomy.

Depending on the part of the stomach removed, intestine may be reconnected to the other part of the stomach or to the oesophagus. In severe duodenal ulcers it is necessary to remove the lower portions of the stomach called pylorus and upper portion of the stomach is called duodenum. If there is sufficient portion of upper duodenum remaining then Billroth-1 procedure is followed, where the remaining portion of the stomach is reattached to duodenum before the bile duct of pancreas. If the stomach cannot be reached to duodenum then Billorth-2 procedure is performed where the remaining portion of the duodenum is sealed off.

Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall. Total gastrectomy along with radical lymphadenectomy includes distal pancreatectomy and splenectomy which was favoured by Brunschwig in 1948. Maruyama modified this procedure by preserving distal pancreas so called pancreas preserving radical total gastrectomy. The technique of pancreas preserving total gastrectomy with radical systemic lymphadenectomy by preserving splenic artery and vein as far as branching-of the major pancreatic artery is described.

Gastrectomy carries risk of complications, such as infection, bleeding and leaking from the area that has been stitched together. Gastrectomy may also lead to problems caused by reduction in ability to absorb vitamins, such as anaemia and osteoporosis. Dumping syndrome affects people after gastrectomy. It occurs when particularly sugary or starchy food moves suddenly into small intestine.

Prostate cancer by surgical treatment involves removal of entire prostate and seminal vesicles. When the cancer is confined to only the tissues, surgery alone can cure localized prostate cancer. The Prostate Serum Antigen (PSA) levels should be undetectable after prostatectomy. Nerve sparing radical prostatectomy is ultimately designed to preserve man’s sexual function. The success rate for preserving sexual potency is dependent upon few factors –man’s age, quality of his erection function prior to surgery and surgeons skills in protecting and preserving nerves during the prostate nerve operation.

Prostate is also covered by endo-pelvic fascia like other organs in the pelvis, which has two layers parietal and visceral. The parietal components cover the levator ani muscles. Visceral organs cover all organs in the pelvis region prostate, bladder and rectum. Visceral part of the endopelvic fascia is fused with anterior fibro vascular stroma of prostate at the upper ventral wall of prostate. Parietal and visceral components of the endopelvic fascia are fused at the lateral aspect of the prostate and bladder. This area is observed as whitish line which is called as arcus tendinous fascia pelvis and extends from puboprostatic and pubovescical ligaments of ischial spine. The periprostatic fascia contains all fasciae on the prostate which are external to the prostatic capsule and the fascia is named as lateral pelvic fascia, Para pelvic fascia and prostatic fascia. The periprostatic fascia is divided into three basic parts anterior periprostatic fascia, lateral periprostatic fascia and posterior prostatic fascia and seminal vesicles fascia.

Epithelial cells of thymus gland are affected by thymoma and they may be either benign or malignant. Thymomas are mostly are associated with neuromuscular disorder such as myasthenia gravis. Thymoma if diagnosed once it can be surgically removed, but in some rare cases chemotherapy to be performed one-third of the patients have the tumours found that they have an associated autoimmune disorders

3 histological types of thymoma depending on type of cells by microscopy are,

Type-A is the epithelial cells have fusiform type of shape.

Type-B is presence of epithelioid shape.

Type-AB is presence of both types of cell shapes.

Cortical epithelial cells in thymus have huge cytoplasm, vesicular nucleus with finely divided chromatin and small nucleoli and cytoplasmic filaments.

If the tumour is apparently invasive then large preoperative chemotherapy or radiotherapy may be used to decrease the size and improve the resectabilty before surgery is attempted. When the tumour is in early stage no therapy is required. Invasive Thymomas require additional treatment with radiotherapy and chemotherapy. Reoccurrence of Thymomas observed in 10%-30% of cases up to 10years of surgical resection and in majority of cases pleural reoccurrence is observed. Recently surgical removal of pleural reoccurrence is followed by hyper thermic intrathoracic perfusion chemotherapy or ITH.

Surgical mediastinoscopy is a pre-therapeutic staging activity with highest sensitivity and specificity, but it is dependent on number of lymph nodes sampled and has technical limitations especially of left upper lymph lobe tumours. Accurate pre-treatment staging of mediastinal lymph nodes in lung cancer is essential to determine prognosis and treatment for patients with involved mediastinal lymph nodes may not benefit from upfront surgical resection. Computerized tomography (CT) and positron emission tomography lack both sensitivity and specificity for accurate lymph node staging.

There is growing acceptance of video assisted Thoracoscopic surgery in surgical treatment of early stage lung cancer. The difficulty in performing mediastinal lymphadenectomy thoracoscopically may affect continued use of this procedure.

Lymphadenectomy is the surgical removal of one or more groups of lymph nodes.

Cystectomy is the removal of a part or complete bladder. Cystectomy treats bladder cancer that has spread to walls of the bladder.

· Partial cystectomy: It is removal of one part of bladder. It is used to treat cancer that has invaded at one area of the bladder. Partial cystectomy is the best choice to the cancer which is not at the openings of passage of urine.

About Conference

International conference on Robotic Oncology2018 which is going to be held during October 26-27, 2018 Osaka, Japan by conference series ltd, which assembles all the people around the world to have a knowledge and discussion on the presently developing Robotic Oncology where the medical science students, pharmacists working in R&D, medical professors, haematologists, oncologists, bioinformatics, biotechnology students and researches to empower their knowledge by listening to the most renowned scientists from all over the world.

Conferenceseries Ltd organizes 300+conferences, 500+workshops and 200+ Symposiums on different branches like clinical, medicine, pharmaceutical sciences & Technologies every year from all over the world U.S.A, U.K, U.A.E, Singapore, Malaysia, Korea, Australia, India, Indonesia and from 1000 more scientific societies and published 500 open access journals with 30000 eminent personalities & reputed scientists as editorial members.

Better precision and control offered by the da Vinci system allows the surgeon to perform delicate surgeries like prostate surgery to perpetuate the nerve fibres and blood vessels attached to the gland.

The ability of the di Vinci system is to scale the surgeon’s movement to allow for better cancer clearance and to protect the healthy tissues.

Japan is often referred to by the famous epithet “land of rising sun”. Japan is a leading nation in scientific research, particularly in field’s related to natural sciences and engineering. The country ranks second among the most innovative countries in the Bloomberg innovation index. The amount spent on the research and development by gross domestic product is third highest in the world. And the dual arm construction robot with remote control was developed by group of Japanese researchers for disaster control.

Target audience

· Oncologists

· Radiologists

· Haematologists

· Gynaecologists

· Dermatologists

· Biotechnology students

· Bioinformatics students

· Research scholars in cancer

· R&D department in pharmacy

· Robotic science researchers

· Cancer research institutes

· Professors & Students from cancer research centres

· Cancer research universities in Asia-pacific regions

Market analysis

Global robotic surgery market 2015-2020 report analyzes the key players in the global robotic surgery market such as Auris surgical robotics,intuitive surgical, Stryker and titan medical. The report also presents a competitive analysis of the market by product type, by application, by volume, by end-user and by geography.

The radiation oncology market is growing globally due to a number of factors centered on the aging of the population and the benefits accrued from new technology. The number of new cancer cases diagnosed annually is projected to increase from 13.9 million in 2012 to 20 million by 2022. The increase in new cases is due to a steadily aging population.

Radiology oncology surgical robot market driving forces relate to an opportunity to achieve change in medical practice regarding the treatment of cancer. Change would lead to utilization of stereotactic body radiosurgery more regularly as an alternative surgery or other treatments.

9000 additional treatment machines will be required by 2020 in developing countries. China, India and Brazil are estimated to require over 3800, 1200 and 400 additional machinery. Demand in emerging markets coupled with ever increasing incidences of cancer, represent additional drives for continued growth.

Radiology oncology surgical robot device markets at $4 billion in 2015 are anticipated to reach $7.3 billion by 2020 as next generation devices, systems and instruments are introduced to manage cancer through radiation excision that eliminates open cutting in the body. Patients tolerate excision that eliminates open cutting in the body. Patients tolerate the surgery well, walking out the hospital after the procedure no longer bothered by healing or infection from an incision.

Global outlook of robotic surgery market

Technavio’s market research analysts predict the global robotic surgery market to grow steadily during the forecast period and post a CAGR of more than 11% by 2020. This industry research report identifies the increased focus of surgeons towards minimally invasive surgeries to be one of the major factors then will have a positive impact on the growth of the surgical robotic market in the coming years. Benefits such as reduced recovery time, reduced hospital stay and less post-operative pain have resulted in the increasing preference of minimally invasive surgeries by both patients and surgeons.

Why to Attend?

Empowering knowledge in public with recent advances in robotic oncology and treatment from around the world focusing on oncology and advances in the robotic oncology and surgeries, this is the best opportunity to attend the largest assemblage of participants. World renowned speakers, scientists and professors will have a thought provoking message on new advancements in robotic oncology and surgeries.

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